Quitters as Winners: Role of tobacco free zones in smoking cessation

Tobacco use is a major global healthconcern claiming eight million lives annually. Sri Lanka has made major strides in reducing the overall smoking prevalence rate in recent years, but tobacco still claims more than 20,000 lives each year. 

‘Commit to Quit’is the theme of this year’s World No Tobacco Day marked on 31st May 2021, and provides a welcome focus on smoking cessation by advocating strong cessation policies, increasing access to cessation services, and empowering users to successfully quit the deadly habit through ‘quit and win’ initiatives.

The benefits ofsmoking cessationgo beyond the individual; most immediately and directly through reduced involuntary smoke exposure and higher disposable incomefor household members. It is, therefore, crucial to have effective, long-term cessation interventions.

According to the latest IPS research, strengthening existing Tobacco Free Zones (TFZs) and creating new TFZs are a promising initiative in promoting smoking cessation. This article examines the effectiveness of prevailing TFZsand suggests ways to improve them so that Sri Lanka’s public healthcare can be further strengthened.

TFZs in Sri Lanka
TFZs are geo-specific areas where the sale of tobacco is prohibited. This is a community-led decision, rather than a top-down imposition. 

Usually, Public Health Inspectors (PHIs) work with the whole community, and the decision to stop tobacco sales is taken by local shop-owners, with the support of community leaders, NGOs, village-level voluntary organisations, religious leaders and other influential actors with the sole aim of safeguarding public health.

The TFZ-approach is to conduct a series of discussions, led by the area PHI and community members, with retail shop owners to stop the sale of tobacco smoking related products. Once all the parties come to an agreement, the area is declared as a TFZ. 

Sri Lanka has to-date established close to 200 TFZs including Mahakumbukkadawala in Puttalam district, Gurudeniya in Kandy district,Nugalanda in Ampara District, Walagedara in Kalutara district, Hakmana in Matara district and Beliatta in Hambantota district.

TFZs as long-term policy measure 
IPS research shows that TFZs are cost-effective and crucial to reach a wider audience within a shorter period of time. TFZs are also proven to be beneficial in achieving higher quit rates among those who smoke while creating a highly visible tobacco control environment. 

Research encourages the TFZ model as a promising policy option for tobacco cessation not only because it encourages the remaining stock of smokers to quit but also reduces their chances of becoming victims to pandemics such as COVID-19. Scientific evidence shows that smokers are at a higher risk of developing severe COVID-19 outcomes and death. Further,studies also recommend thatsuccessful smoking cessation interventions should be a priority especially during the COVID-19 pandemic. Therefore, strengthening the prevailing TFZs should be a long-term policy measure in Sri Lanka’s tobacco control agenda.

Way forward
TFZsare meant to be a community-based programme, but according to IPS research, the prevailing ones are highly dependent on PHIs. This affects their sustainability as the PHIs are regularly transferred. This calls for greater community involvementright from the initiation while the PHIs should ideally play an advisory role.       
Voluntary and other organisations, which have worked on tobacco control, can continue to extend their support by providing training to community leaders to enable them to assume stronger leadership roles and thereby ensure greater sustainability. 

This can involve training sessions, educational programmes and awareness campaigns that communicate clear messages to children, youth and businesses in particular.

It is equally important to identify implementation bottlenecks and understand the power structure around TFZs at the local level. For instance, lack of support from the community members and other government officers, and industry interferences are some key issues, which must be addressed when expanding the programme. 

COVID-19 has motivated millions of tobacco users to quit, and improving prevailing TFZs will not only help people quit, but will also reduce their chance of falling victim to future pandemics. 

A multisectoral approach can be followed in sustaining TFZs, bringing together all stakeholders, especially in areas where smoking prevalence is high; this includes soliciting the participation of political actors to ensure its success.
(Chathurga Karunanayake is a Research Officer at IPS with research interests in behavioural economics, labour economics, infrastructure development and regulatory governance. She holds a BA in Economics (Honours) and a Certificate in International Relations and Affairs from University of Colombo, and a DipLCM from University of West London, UK. Talk with Chathurga - [email protected])